EEG alpha power and anesthesia induction in infants
Myron Yaster MD and Jerry Chao MD
Original article
Chao JY, Gutiérrez R, Legatt AD, Yozawitz EG, Lo Y, Adams DC, Delphin ES, Shinnar S, Purdon PL. Decreased Electroencephalographic Alpha Power During Anesthesia Induction Is Associated With EEG Discontinuity in Human Infants. Anesth Analg. 2022 Dec 1;135(6):1207-1216. PMID: 35041633
Electroencephalogram (EEG) voltage suppression or discontinuity can occur at high concentrations of anesthetic drugs reflecting a pattern of suppression or transient attenuation of electrocortical activity. EEG discontinuity was common and observed in 37% of infant subjects during the period of anesthesia induction.
Remembering the Classics: Cyanosis-Do You Think the Blood Looks Dark?
Alan Jay Schwartz, MD, MSEd
Before the widespread availability of pulse oximetry, clinicians relied on their ability to visualize cyanosis by observing the color of the blood after incision and by the color of the mucosa. Lundsgaard and Van Slyke in 1919 that the ability of clinicians to recognize cyanosis was, well, terrible and 5 gm/dL of reduced hemoglobin was necessary to produce visible cyanosis.
A (very) modular update of the ASA Fasting Guidelines
Lynne Maxwell MD and Myron Yaster MD
Original Article
Joshi GP, Abdelmalak BB, Weigel WA, Harbell MW, Kuo CI, Soriano SG, Stricker PA, Tipton T, Grant MD, Marbella AM, Agarkar M, Blanck JF, Domino KB. Update of 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration-A Modular the 2017 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting. Anesthesiology. 2023 Feb 1;138(2):132-151.. PMID: 36629465.
The ASA has revamped its NPO guidelines for adults and pediatrics. Although many pediatric programs have changed their NPO guidelines for clears to one hour, the new guidelines continue the 2 hour waiting period and concluded that there is insufficient evidence concerning benefits and harms to recommend” a 1-hr fasting time for clear liquids in pediatric patients.
Perioperative anaphylaxis
Myron Yaster MD and Lynne G. Maxwell MD
Original review article
Tacquard C, Iba T, Levy JH. Perioperative Anaphylaxis. Anesthesiology. 2023 Jan 1;138(1):100-110. PMID: 36413685
Diagnosing anaphylaxis in anesthetized patients may be difficult. Acute hypotension, bronchospasm, and hypoxemia can easily be confused with other more common intraoperative events like excessive anesthesia, an endotracheal tube tickling the airway, pulmonary edema, aspiration, transfusion related acute lung injury (TRALI), air embolism, sepsis, etc. We recommend that you open and use the PediCrisis app rather than relying on your memory.
Pediatric Obesity Addendum and reader response
Lynne G Maxwell MD
Lynne provided more information about glucagon like peptide-1 receptor agonists in the medical management of obesity. Mark Schreiner answered the question are obese patients at higher risk of pulmonary aspiration of gastric contents. NO.